Yanira D. Kivi 
the metaverse happens – we are told – although it is difficult to know exactly what this means. Some companies use virtual reality to recreate office life to conference rooms, for some reason. And, of course, virtual reality is important for games and other entertainment.
But virtual reality is also increasingly used in healthcare, especially as more and more services are remote.
About 200 hospitals in the United States use virtual reality tools to not only help train doctors, but also to help manage patients’ pain from surgery, irritable bowel syndrome or cancer, Brennan said. Spiegel, director of health services research at Cedars-Sinai Medical. Center. And recently, applications of the technology have grown to include the diagnosis of conditions such as glaucoma.
The following is an edited transcript of host Meghan McCarty Carino’s conversation with Spiegel.
Brennan Spiegel: An example of using virtual reality for glaucoma came during the pandemic, when there was an example of a patient at home who really needed to have their eyes checked. And his doctors have developed software so he can do it at home, in the VR headset, to decide if he needs to be seen or treated, etc. And so, be it that or a number of other conditions, virtual reality is proving to be a very interesting platform to enable accurate diagnosis at home.
Meghan McCartyCarino: It appears that this type of home diagnostics with a home device has the potential to reach populations that might be less likely to visit a doctor’s office. But aren’t they the same demographics that are probably less likely to own a VR headset, which currently costs hundreds of dollars?
Spiegel: You are absolutely right. And currently, we have a study funded by the National Institutes of Health to bring virtual reality therapies to rural America. And so the idea is that we can provide in-home mental health services in rural Alabama, Louisiana, and central California using virtual reality to help manage pain. And we increasingly have to rely on insurance to start paying for these kinds of evidence-based treatments, rather than, say, continuing to support only opioids for pain. It appears to be both effective and cost-effective in supporting other non-opioid pain treatments that can be delivered remotely in people’s homes.
McCarty Carino: What is the current status of whether insurance would cover treatments like this or devices like these? And could they cover them in the future?
Spiegel: Absolutely, they can and probably will. It is an evolving field. The Food and Drug Administration, of course, has now gotten involved in this area and, in fact, has a name for it. It is now called MXR, or Extended Medical Reality. And since the FDA has gotten involved and we’re starting to see FDA-approved treatments, insurance companies are of course starting to take notice. And in some cases, insurance covers virtual reality when used as part of an already billable service, but is not itself a separately billable service. So we’re going to have to keep pushing that, but time will tell.
McCarty Carino: What do some of these virtual reality medical therapies actually look like? Can you kind of describe to me what a patient might feel?
Spiegel: Yeah, so for example, for a virtual reality home clinic, when a patient walks into the headset, they’re actually in a clinic. They can see a hall, there are corridors and treatment rooms that we are gradually unlocking on our side. And people can start moving step by step through these different rooms. And so those range from relatively simple environments, like being in a modified exam room and then becoming a doctor and examining a patient in a role reversal pattern, to something totally fantastical, like walking into a room movie that represents your own mind and then see the scenes on the screen that represent your thoughts. And it starts to confront people with this notion that they can think about thinking, and that the projectionists in the back of the theater are putting thoughts on the screen that they maybe can’t control. And it brings up all kinds of interesting philosophical and psychological discussions that are very difficult to have in a regular treatment room or even with a therapist. So, with virtual reality, we can do all kinds of fantastic things: put people in and out of different bodies, teach them about their minds and bodies, and how to help them control their state. And so those are just a few examples of the different types of environments that we create in VR.
McCarty Carino: Last year we saw research on artificial intelligence used to help diagnose skin cancer, but it was less accurate on darker skin tones, in part because of the images it was trained on. What are we doing to avoid some of these same mistakes for these virtual reality tools?
Spiegel: Yes, absolutely correct that we need to think of all our patients when creating any healthcare innovation, not just digital tools. But in healthcare, what we’re also learning is that we need to work with a wide variety of patients early and often before programmers start creating these treatments. So in this area of extended medical reality, we have now developed a three-step process to develop and validate treatments in partnership with patients. And just like the FDA has phase one, phase two, and phase three trials, now we have here what we call VR one, VR two, and VR three trials. And the VR one trial involves working with a diverse group of patients and end users who represent the target population of the proposed treatment, and learning from them what their needs, preferences, knowledge, attitudes and beliefs, and to integrate them. using user-centered design in the development of the treatment itself.
McCarty Carino: What do you see as the future of how this technology could be integrated into the health care system?
Spiegel: Well, I think it’s inevitable that it will happen. It is already happening. We’ve heard a lot about the metaverse, and I think in healthcare it’s our responsibility to figure out how to develop a corner of that metaverse that’s specifically designed to support human health ideally using treatments based on evidence that will eventually be approved by the FDA. And the future will be to prescribe these therapies to people at home who already have, more and more, access to these helmets or will be able to have access to them via insurance.
Related Links: More From Meghan McCarty Carino
Here’s more on some of the use cases for VR processing that Spiegel and Cedars-Sinai Researchincluding some promising studies on pain management. At the end of last year, the FDA approved the marketing of a prescription virtual reality system to treat chronic low back pain. It’s part of a new wave of prescription software-based treatments known as digital therapies.
According to a new article published in a trade publication MedTech Divingthese include a game to treat ADHD in children, software that helps cancer patients manage their symptoms, and apps to treat substance use disorders and insomnia.
There’s a lot of investment in space, but as Brennan Spiegel noted, those hurdles are faced with insurance coverage, which is important because the price of those programs can be quite high, reflecting testing intensive clinics that have to go into something FDA approved as a treatment.
MedTech Dive reports that the Somryst anti-insomnia app is priced at $899. And I don’t think you can get it for free if you allow those distracting banner ads.
